The Pain Paradox
“The soul is like a violin string. It makes music only when it is stretched.”
– Neal Maxwell
The following is an excerpt from my newest book set to be published in the next 2 to 3 weeks.
Summer 1992
What struck me first was the color of her eyes as she looked up at me when the paramedics wheeled the stretcher into the trauma room. Her eyes were a piercing shade of ice blue. The paramedics rattled off the details of the motor vehicle accident as if she weren’t even there:
“19-year-old female, rollover MVA, ejected from the vehicle, traumatic amputation of right leg.”
I immediately thought to myself, Whoa, whoa, whoa. Wait a minute, hold on; I don’t see a lot of blood on the sheet.
At that exact moment, another paramedic rushed in with a big red plastic bag over his shoulder. He dumped it on a counter with a loud thud and announced, “I brought this in so you can reattach it.” It was her leg. She had sustained a traumatic amputation just above the knee. All the major arteries were in spasm, which was why the blood loss was minimal.
The trauma team began the assessment: Airway… Breathing… Circulation… No head trauma; lungs sounded okay. We started taking X-rays of her chest and pelvis when I noticed something. Dark, merlot-colored blood was pooling from what appeared to be an open fracture around her pelvis.
The statistics started to dance in my head. Crap. Open pelvic fracture and a traumatic amputation of a leg. Not good. She grabbed my arm and whispered softly, squeezing my hand, “Please don’t let me die. I don’t want to die. Please, please don’t let me die!”
At about the same time, one of the ER nurses called out, “I can’t get a pressure on the machine; I’m getting a pressure of 70 palpable, but it’s dropping!”
As I conducted a head-to-toe assessment, a cold, clinical fact hit me: In this type of injury, most studies indicate that mortality rates are some of the highest of any trauma insult. Insult? I thought, She’s dying! Statistics can give us a sense of support, comfort, and safety, but in this case, they only highlighted the futility and hopelessness of the situation.
But there is always the possibility of a miracle. I have witnessed a few.
The trauma team was assembled, and ortho had just arrived. We knew that her best chance was to stabilize the pelvic fracture as quickly as possible, as hemorrhaging around pelvic fractures is lethal without rapid control.
We started preparing her for the OR. Two IV lines? Check. Fluids wide open? Check. I instructed the lab techs, who were finishing up her blood draw, “Send blood for type and cross, and tell the blood bank to have O-negative ready for her when she hits the OR.”
As they wheeled her out, she looked at me with a kind of fear and despair that is still etched in my mind, even thirty years later. All I could manage to say was, “We are doing everything we can. Don’t be afraid; you aren’t going to die.”
She coded about twenty minutes into the procedure and didn’t survive the resuscitation efforts.